Published online Jun 16, 2021. doi: 10.4253/wjge.v13.i6.189
Peer-review started: February 1, 2021
First decision: March 1, 2021
Revised: March 12, 2021
Accepted: May 21, 2021
Article in press: May 21, 2021
Published online: June 16, 2021
Primary aorto-enteric fistula (PAEF) is a rare condition, traditionally treated in the acute, bleeding phase with open surgery or endovascular repair. However, these approaches have high morbidity and mortality, indicating a need for new methods. With advances in endoscopic techniques and equipment, haemoclipping of fistulas has now become feasible. Therefore, we present a systematic review of the English literature and a rare case of a PAEF successfully treated by endoscopic haemoclipping.
A 74-year-old man with an abdominal aortic aneurysm presented with symptoms of haemorrhagic shock and bloody stools. An oesophago-gastro-duodenoscopy was performed with haemoclipping of a suspected PAEF in the third part of the duodenum. Afterward, a computed tomography-angiography showed a contrast filled protrusion from the abdominal aortic aneurysm. Based on the clinical presentation and the combined endoscopic and radiographic findings, we argue that this is a case of a PAEF.
Endoscopic therapy appears capable of achieving haemodynamic stabilisation in patients with bleeding PAEF, serving as a bridge to final therapy.
Core Tip: Primary aorto-enteric fistula is a rare condition with high mortality. The current acute phase treatment is surgical or endovascular and is followed by high morbidity and mortality. The aim of this systematic review and case report was to put forward endoscopic haemoclipping as a new treatment option in the acute bleeding phase of an aorto-enteric fistula and, in a systematic manner, to search the literature for any evidence behind this therapy, including other reported cases.